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Developing Nonclinical Skills in Ambulatory Care Settings


Thu Mar 04 2021

Developing Nonclinical Skills in Ambulatory Care Settings

There is no question that the healthcare industry requires healthcare workers to achieve clinical competencies and demonstrate those competencies through practicum, externships, and residency rotations. Licensures and continuing medical education (CMEs) are also necessary to ensure clinical skills remain up-to-date and meet healthcare regulations. Yet, research proves only 10 percent of patient health is driven by clinical care. So, what happens when the delivery of clinical care and skills aren’t enough?

In this case, training in nonclinical skills such as self-management support, patient-driven goals, and improving overall patient experience of care was the answer. At the end of the last training session, one medical assistant (MA) approached me to share, “I still don't have what I need to do my job.” I left asking myself, “What is missing?”


After I left the interaction, the answer became clear: From the first day of school until retirement, nonclinical and clinical abilities must be incorporated. While working with one large health system, I found these keys to success:

  • Integrate nonclinical competencies within the curriculum in medical schools. Every healthcare worker, from MAs through physicians, should have opportunities to see and practice these skills throughout their educational experience. The same skills may be new for faculty, so be sure to integrate professional development opportunities for them as well.

  • Create competency checklists that include the nonclinical skills. For example, every MA must demonstrate clinical competencies throughout their externships. Adding patient-centric skills to the checklist enables MAs in training to demonstrate their abilities and allows the student to receive immediate feedback from supervisors.

  • Include nonclinical skills in the written scope of practice and across all job descriptions. Foremost, specify the performance requirements. Move beyond “proficient in-patient driven goal setting” and move toward “demonstrate patient driven goal setting for at least three patients with chronic conditions every quarter.”

  • Implement consistent and ongoing opportunities for all healthcare staff to shadow, practice, and model (see one, do one, teach one) in the job setting.

  • Assess individual performance as well as the nonclinical skills still missing across the organization. For example, if the nonclinical skill of patient-driven goal setting is not improving patient care, what is missing? Perhaps all care team-members would benefit from furthering their skills in motivational interviewing, a key indication that patients are ready to develop health goals and motived to change their behaviors.

  • Evaluate the return on investment across the organization. Does patient-driven goal setting lead to improved health outcomes, decreased hospitalizations, and increased patient experience of care? If so, the fiscal impact of these outcomes can be measured and support the value proposition for the ongoing development, refinement, and focus on nonclinical skills.

Six years later, the same MA has since become certified, created and promoted the lead MA job title, and been asked to model their skills at regional and national healthcare transformation events. I’d say the goal was achieved with the countless patient stories about that one MA “really understands what I need” and “listens to me.”

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